Which of the following is a late sign of compartment syndrome?

• A. Pain with passive stretch
• B. Paresthesias
• C. Loss of distal pulses
• D. Swelling

Answer: (C)

Compartment syndrome progresses from painful warning signs to nerve and muscle ischemia, with pulses often remaining intact until late. The earliest clue is severe pain that’s out of proportion to exam, especially pain on passive stretching of the involved muscles. Paresthesias and later weakness or paralysis follow as nerves become ischemic. Swelling can occur but isn’t specific or predictive of timing.

Loss of distal pulses is a late sign because arteries can stay patent even as tissue pressure rises and nerves and muscles become ischemic. When pulses disappear, perfusion has fallen to a critically low level, indicating significant and potentially irreversible injury and signaling the need for urgent decompression. In practice, don’t rely on pulse status alone; if clinical signs point to compartment syndrome, treat promptly to prevent lasting damage.